Don’t Let Any Doctor Touch Your Skin…

After saving up for months, Amy was ready to get laser treatments for acne scars on her chin. Then she saw an ad in a local paper for a doctor doing cosmetic work; the prices listed were very reasonable. “I did research and discovered he was board-certified in internal medicine, not dermatology, but I thought, Who cares?” recalls the West Coast resident. “His office was in a fancy zip code, when I met him he seemed competent, and he’d gone to a good school. So I gave myself a thirty-seventh-birthday present.” After two laser sessions, though, her skin was worse—not only did the scars on her chin appear unchanged, but three new ones had cropped up on her cheeks; they looked like red, angry cigarette burns.

Once, only dermatologists and plastic surgeons did in-office cosmetic procedures such as laser work, liposuction and lip plumping. But the booming aesthetic industry has attracted gynecologists, urologists and even oral surgeons who want a piece of this multibillion-dollar pie—and the results aren’t always beautiful.

Close to 60 percent of doctors surveyed by the American Society for Dermatologic Surgery (ASDS) have seen an increase in complications since 2005 from cosmetic work done by nonspecialist M.D.s as well as aestheticians and the like at medi-spas. Derms and plastic surgeons told Glamour about women left with second-degree burns on their pubic area after laser hair removal, lumpy lips from misguided collagen injections and droopy, over-Botoxed lids.

Women in their twenties and thirties are more at risk. Since non-derms often advertise discounted rates, “they tend to attract younger, cost-conscious patients,” notes Susan Van Dyke, M.D., a board-certified dermatologist in Paradise Valley, Arizona, who’s developed a name for herself fixing badly done cosmetic work. “They’re known as ‘derm pretenders,’” adds Kenneth Beer, M.D., a clinical instructor in dermatology at the University of Miami. “Some even list themselves in the phonebook as ‘dermatologists.’”

Statistics show that, despite the ailing economy, procedures like Botox and laser hair removal remain popular among women younger than 35. “Women still want these things,” says Dr. Van Dyke, “but now they want to find the lowest price possible. And that often means poor-quality work.”

Are so-called derm pretenders legal? In a word, yes. “Once medical students have gone through basic training and earned an M.D., they have the right to practice in whatever area of medicine they want to—but that doesn’t mean they are fully trained as specialists,” says Kevin B. Weiss, M.D., president of the American Board of Medical Specialties. Doctors who choose to specialize in one area, such as dermatology, undergo years of residency. And when new technologies crop up, they can take seminars to learn the techniques.

Non-derms who decide to offer cosmetic services may go to some of those same courses. Although laws vary by state about who can actually perform the procedures, sometimes it’s a free-for-all. “Here in Arizona,” says Dr. Van Dyke, “you could be a window washer, go take a class and start doing laser treatments.” That’s where dermatologists are said to have an edge: They typically know exactly how to treat skin complications that may arise.

The trend isn’t going away anytime soon. As insurance companies reduce payments to doctors for basic appointments, a lot of M.D.s say they need supplemental income. “When I was practicing family medicine, I was coming home at nine at night and still not making enough money to support my family,” says one doctor who now does Botox, wrinkle fillers and laser treatments at a California medi-spa. “So are there financial reasons for me to have gone into cosmetic dermatology? Absolutely. But I took many courses and practiced on friends and family before I performed on patients. And when I was on a learning curve, I’d be honest and tell them that I hadn’t done many of those procedures. And I have never had a complaint.”

Others in the medical field are also unconvinced certification in a specialty is critical. “Physicians add to their skill sets all the time with continuing education,” says Lori J. Heim, M.D., president of the American Academy of Family Physicians. “It’s not about who is doing what. The danger to patients comes from people who are not well-trained. It has less to do with what you’re board-certified in.”

Yet that remains a point of contention among top experts. “Board certification in a specialty is the only reliable measure of competence,” says Clarence Braddock III, M.D., associate dean at Stanford University School of Medicine. He also questions doctors who advertise doing cosmetic work: “Persuading patients to get procedures they don’t need raises ethical concerns.” Those ubiquitous WE OFFER LASER HAIR REMOVAL signs in ob-gyn offices can make women uncomfortable too. As Lily Hamburger, 23, a staffer at a nonprofit group in Washington, D.C., puts it, “I do not want to worry that my gynecologist is judging the way I look down there.”

With the economy in free fall, a number of reputable dermatologists are offering patients more value for their money. “Some have promotions, such as if you get your lips plumped up, the second syringe of filler may be less expensive,” says Dr. Van Dyke. But be wary of doctors who advertise rock-bottom prices or, worse, offer coupons. “I wish I hadn’t been so sold on price,” says Amy, who spent $5,000 to have a board-certified dermatologist fix her wreck of a laser job and still has to use cover-up. “You get what you pay for.”

How to Find a Good Skin Doc

To check if a doctor is board-certified in dermatology or plastic surgery, you can call the American Board of Medical Specialties (866-275-2267).

Call your regional medical board (google your state’s name and “medical board” to find it) to make sure the doctor has no pending disciplinary action, and that her license is current.

No matter what the provider’s credentials, ask how many times she’s done the procedure; you want to hear she has at least a few hundred under her belt. If you sense B.S. or if she’s giving you a hard sell, leave.